Position Overview: The Billing Specialist, Team Lead is responsible to provide administrative support to the Billing Manager for the overall billing functions of the designated billing team. This includes but is not limited to providing the appropriate coverage when needed, working, and overseeing billing projects, being a resource to the billing team, training newly hired team members, and having an active role in End of Month processes to ensure a smooth close. The Billing Specialist, Team Lead will also complete the daily entry of charges for their assigned facilities and provide support to both the team members and the Billing manager in various capacities. 

Responsibilities:

• Provides assistance to the Billing Manager in the following areas:
  • Provide 1st level support and guidance to the team.
  • Provides Functional training for new team members.
  • Provides coverage for team members out of the office.

• Performs all required billing functions resulting in clean claim transmissions as needed.
  • Ensure late Charges, DFNB & Hold Timelines Reports are worked daily.
  • Extract information from medical records, operative notes, invoices, progress notes and discharge paperwork to ensure completeness and accuracy of charge entry.
  • Capture implants, high-cost supplies, high-cost drugs, post op pain blocks and observations times prior to charge submission
  • Review accuracy of invoice details, including customer billing instructions, pricing, discounts, state sales tax, etc.
  • Pull and prep operative notes from the designated transcription company.
  • Execute the recurring billing workflow and generate and transmit claims daily.
  • Ensure timely follow-up and resolution of internal and external inquiries of billing issues (i.e., operative notes, POPM form, invoices, or implant pricing etc).
  • Reconcile revenue and billing during the period-end close process.
  • Complete accurate charge entry for all assigned cases and upload to designated electronic claims clearinghouse daily.
  • Resolve claim rejections daily to ensure clean claims are transmitted and received by the appropriate payer.
  • Maintain current knowledge of health care billing laws, rules and regulations and developments

Requirements:

• 2+ years of Surgical Hospital, ASC revenue cycle, or orthopedic charge entry experience.
• Ability to read and interpret managed care contracts.
• Must communicate effectively, both verbally and in writing, with internal and external clients.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook
• Cerner, Meditech, Advantx, CPSI, Vision, HST Pathways, Waystar experience preferred.
• High School Diploma or equivalent.